‫بسم هللا الرحمن الرحیم‬
dr asadian amoli 1391-24 bahman
‫سالم به همکاران عزیز‬
dr asadian amoli 1391-24 bahman
DYSPNEA
by Dr Asadollah Asadian
dr asadian amoli 1391-24 bahman
Dyspnea - common complaint/symptom
• “shortness of breath” or “breathlessness”
Defined as abnormal/uncomfortable breathing
Multiple etiologies • 2/3 of cases - cardiac or pulmonary etiology
dr asadian amoli 1391-24 bahman
HOW TO DESCRIBE
THESE SENSATIONS
Cannot get enough air
Air does not go all the way down
Smothering feeling in the chest
Tightness in the chest
Fatigue in the chest
dr asadian amoli 1391-24 bahman
Normal person may experience the physiologic dyspnea
during heavy exercise
dr asadian amoli 1391-24 bahman
DIFFERENTIAL
DIAGNOSIS
Composed of four general categories
•
•
•
•
Cardiac
Pulmonary
Mixed cardiac or pulmonary
non-cardiac or non-pulmonary
dr asadian amoli 1391-24 bahman
PULMONARY
ETIOLOGY
COPD
Asthma
Restrictive Lung Disorders
Hereditary Lung Disorders
Pneumonia
Pneumothorax
dr asadian amoli 1391-24 bahman
CARDIAC ETIOLOGY
CHF
CAD
MI (recent or past history)
Cardiomyopathy
Valvular dysfunction
Left ventricular hypertrophy
Pericarditis
Arrhythmias
dr asadian amoli 1391-24 bahman
MIXED
CARDIAC/PULMONARY
ETIOLOGY
COPD with pulmonary HTN and/or cor pulmonale
Chronic pulmonary emboli
Pleural effusion
dr asadian amoli 1391-24 bahman
NONCARDIAC OR
NONPULMONARY
ETIOLOGY
Metabolic conditions (e.g. acidosis)
Pain
Trauma
Neuromuscular disorders
Functional (anxiety,panic disorders,
hyperventilation)
Chemical exposure
dr asadian amoli 1391-24 bahman
TOXIC DYSPNEA
In the metabolic acidosis (uremiaand
diabetic acidosis, the acid metabolites stimulate the
respiratory center, causing deep and regular respiration
(Kussmanul) with snoring.
dr asadian amoli 1391-24 bahman
ACUTE DYSPNEA
PTE
Pneumonia
Asthma
Anxiety
MI
dr asadian amoli 1391-24 bahman
There is no one specific cause of
dyspnea and no single specific
treatment
Treatment varies according to patient’s
condition
• chief complaint
• history
• exam
• laboratory & study results
dr asadian amoli 1391-24 bahman
‫نا رسایی تنفسی‬
dr asadian amoli 1391-24 bahman
‫انواع نارسایی تنفس‬
‫هیپوکسمیک (تیپ‪) 1‬‬
‫هیپرکاپنیک (تیپ‪)2‬‬
‫‪dr asadian amoli 1391-24 bahman‬‬
‫نا رسایی حاد تنفسی‬
‫‪=po2<60mmgh w‬نارسایی تنفسی هیپوکسمیک ‪‬‬
‫‪FIO2=>50‬‬
‫‪PCO2.>45mmgh+acidosis‬هیپرکاپنیک نارسایی تنفسی=‪‬‬
‫‪dr asadian amoli 1391-24 bahman‬‬
‫علل هیپوکسی‬
‫کاهش ‪FIO2‬‬
‫اختالل دردیفیوژن ‪‬‬
‫شنت‪‬‬
‫هیپوونتیالسیون‪‬‬
‫‪V/Q mismatch‬‬
‫‪dr asadian amoli 1391-24 bahman‬‬
‫شایع ترین علت نارسایی‬
‫تنفسی در ‪ICU‬شنت است‬
‫‪dr asadian amoli 1391-24 bahman‬‬
‫علل شنت‬
intracardiac
• any cause of a right to left shunt eg Fallot's
tetralogy, Eisenmenger's syndrome
pulmonary
• pneumonia
• pulmonary oedema
• atelectasis
• collapse
• pulmonary haemorrhage
• pulmonary contusion
dr asadian amoli 1391-24 bahman
‫تهویه بدون پرفیوژن‬
‫هوا واردریه می شود ولی تبادل گاز صورت نمی گیرد(به علت فقدان پرفیوژن)در نتیجه‬
‫الوئولها همانند راه هوایی‬
‫عمل میکنند() ‪(physiological dead space‬‬
‫علل‪ -‬نارسایی قلبی (‪ )low cardiac output‬‬
‫افزایش فشارداخل الوئولی (تهویه مکانیکی)‪‬‬
‫‪dr asadian amoli 1391-24 bahman‬‬
CAUSES OF
HYPOVENTILATION
Brainstem
• brainstem injury due to trauma, haemorrhage, infarction, hypoxia, infection etc
• metabolic encephalopathy
• depressant drugs
Spinal cord
• trauma, tumour, transverse myelitis
Nerve root injury
Nerve
• trauma
• neuropathy eg Guillain Barre
• motor neuron disease
Neuromuscular junction
• myasthenia gravis
• neuromuscular blockers
Respiratory muscles
• fatigue
• disuse atrophy
• myopathy
• malnutrition
Respiratory system
• airway obstruction (upper or lower)
• decreased lung, pleural or chest wall com
dr asadian amoli 1391-24 bahman
NERO-PSYCHOGENIC
DYSPNEA
Patient suffer from hysteria will be seen
repetitive deep, signing respiration with
numbness of extremities or lips, spasm.
dr asadian amoli 1391-24 bahman
HAEMATOLOGICL
DYSPNEA
The decrease of oxygen-carrying capacity and oxygen
content develop abnormal respiration and increase heart rate,
such as severe anemia, carbon monoxide.

Hypotension can stimulate respiration when patient suffer
from shock.

dr asadian amoli 1391-24 bahman
ACCOMPANYING
SYMPTOMS
Paroxysmal dyspnea with wheezing, It is present in
bronchial asthma and cardiac asthma. Paroxysmal severe
dyspnea is often seen in acute larynx edema(spontaneous
pneumothoraxmassive pulmonary embolism.
dr asadian amoli 1391-24 bahman
ACCOMPANYING
SYMPTOMS
Dyspnea with chest pain. It is frequently observed in lobar
pneumoniapulmonary infarction(), spontaneous
pneumothorax, acute exudative pleurisy), acute myocardial
infarctionand bronchial carcinoma```````````````````````
dr asadian amoli 1391-24 bahman
ACCOMPANYING
SYMPTOMS
Dyspnea with fever. It is commonly noted in pneumonia,
lung abscesspulmonary tuberculosispleurisy, acute
pericarditisand nervous system diseases.
dr asadian amoli 1391-24 bahman
ACCOMPANYING
SYMPTOMS
Dyspnea with cough and purulent sputum. It is often
present in chronic bronchitis, obstructive pulmonary
emphysema with infection, purulent pneumonia, and lung
abscess; Dyspnea with large amount of foamy sputum is
often seen in acute left ventricular heart failure and
organophosphorus poisoning
dr asadian amoli 1391-24 bahman
ACCOMPANYING
SYMPTOMS
Dyspnea with coma. It suggests cerebral
hemorrhage(pneumonia with shock, uremia, diabetic
ketoacidosis, and acute poisoning.
dr asadian amoli 1391-24 bahman
COMMON CAUSES OF TYPE I (HYPOXEMIC)
RESPIRATORY FAILURE
Chronic bronchitis and emphysema (COPD)
Pneumonia
Pulmonary edema
Pulmonary fibrosis
Asthma
Pneumothorax
Pulmonary embolism
Pulmonary arterial hypertension
Pneumoconiosis
Granulomatous lung diseases
Cyanotic congenital heart disease
Bronchiectasis
Adult respiratory distress syndrome
Fat embolism syndrome
Kyphoscoliosis
Obesity
dr asadian amoli 1391-24 bahman
COMMON CAUSES OF TYPE II
(HYPERCAPNIC) RESPIRATORY
FAILURE
Chronic bronchitis and emphysema (COPD)
Severe asthma
Drug overdose
Poisonings
Myasthenia gravis
Polyneuropathy
Poliomyelitis
Primary muscle disorders
Porphyria
Cervical cordotomy
Head and cervical cord injury
Primary alveolar hypoventilation
Obesity hypoventilation syndrome
Pulmonary edema
Adult respiratory distress syndrome
Myxedema
Tetanus
dr asadian amoli 1391-24 bahman
EASILY PERFORMED
DIAGNOSTIC TESTS
Chest radiographs
Electrocardiograph
Screening spirometry
dr asadian amoli 1391-24 bahman
ABGS
Commonly used to evaluate acute dyspnea
can provide information about altered pH,
hypercapnia, hypocapnia or hypoxemia
normal ABGs do not exclude
cardiac/pulmonary dx as cause of dyspnea
• Remember- ABGs may be normal even in cases of
acute dyspnea
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
Bilateral airspace infiltrates on
chest radiograph film secondary to
acute respiratory distress
syndrome that resulted in
respiratory failure
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
A 44-year-old woman
developed acute
respiratory failure and
diffuse bilateral
infiltrates. She met the
clinical criteria for the
diagnosis of acute
respiratory distress
syndrome. In this
case, the likely cause
was urosepsis
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
dr asadian amoli 1391-24 bahman
‫با تشکر از توجه شما‬
dr asadian amoli 1391-24 bahman
QUESTIONS?
dr asadian amoli 1391-24 bahman